Healthcare Provider Details

I. General information

NPI: 1427989904
Provider Name (Legal Business Name): THOMAS MICHAEL CASTLINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 NORTHWEST BLVD
INDIANAPOLIS IN
46278-1381
US

IV. Provider business mailing address

4510 OCEAN ST APT 3106
INDIANAPOLIS IN
46205-0120
US

V. Phone/Fax

Practice location:
  • Phone: 317-956-1000
  • Fax:
Mailing address:
  • Phone: 574-323-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: